Healthcare Provider Details

I. General information

NPI: 1396278107
Provider Name (Legal Business Name): PEGGY HITCHCOCK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 WINKLER HILL RD NW
DOVER OH
44622-7617
US

IV. Provider business mailing address

20265 EMERY ROAD
NORTH RANDALL OH
44128-7617
US

V. Phone/Fax

Practice location:
  • Phone: 330-364-7694
  • Fax:
Mailing address:
  • Phone: 440-523-9966
  • Fax: 216-584-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number381316
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: